Glycated Albumin and Adverse Clinical Outcomes in Patients With CKD: A Prospective Cohort Study
Mengyao Tang1, Anders H Berg2, Hui Zheng3
1Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Insights
Glycated albumin (GA) levels predict risks of kidney disease progression, cardiovascular events, and death in chronic kidney disease (CKD) patients. GA offers added prognostic value beyond Hemoglobin A1c (HbA1c) for these outcomes.
Area of Science:
- Nephrology
- Endocrinology
- Cardiovascular Medicine
Background:
- Hemoglobin A1c (HbA1c) is a standard glycemic measure but less reliable in chronic kidney disease (CKD).
- Glycated albumin (GA) is emerging as a complementary marker for glycemic monitoring in CKD.
- The association of GA with clinical outcomes in non-dialysis-dependent CKD is not well-established.
Purpose of the Study:
- To investigate the association between baseline glycated albumin (GA) levels and clinical outcomes in a cohort of patients with non-dialysis-dependent CKD.
- To determine if GA provides prognostic information independent of or in addition to HbA1c.
Main Methods:
- Prospective cohort study of 3,110 participants with CKD from the Chronic Renal Insufficiency Cohort study.
- Baseline glycated albumin (GA) levels were measured.
- Cox proportional hazards regression was used to analyze associations with incident end-stage kidney disease (ESKD), cardiovascular disease (CVD) events, and all-cause mortality.
Main Results:
- Higher GA levels were associated with increased risks of ESKD, CVD, and mortality in CKD patients, irrespective of diabetes status.
- The associations between GA and CVD/mortality exhibited a J-shaped pattern.
- GA provided significant prognostic information, particularly when added to HbA1c models in patients with coexisting CKD and diabetes.
Conclusions:
- Glycated albumin is an independent predictor of adverse outcomes, including ESKD, CVD, and mortality, in patients with non-dialysis-dependent CKD.
- GA enhances the prognostic capability of HbA1c for risk stratification in CKD patients, especially those with diabetes.
- GA may serve as a valuable complementary biomarker for glycemic management and risk assessment in the CKD population.
Rationale & Objective:
Hemoglobin A1c (HbA1c) is widely used to estimate glycemia, yet it is less reliable in patients with chronic kidney disease (CKD). There is growing interest in the complementary use of glycated albumin (GA) to improve glycemic monitoring and risk stratification. However, whether GA associates with clinical outcomes in a non-dialysis-dependent CKD population remains unknown.
Study Design:
Prospective cohort study.
Setting & Participants:
3,110 participants with CKD from the Chronic Renal Insufficiency Cohort study.
Exposure:
Baseline GA levels.
Outcome:
Incident end-stage kidney disease (ESKD), cardiovascular disease (CVD) events, and all-cause mortality.
Analytical Approach:
Cox proportional hazards regression.
Results:
Participant characteristics included mean age 59.0±10.8 SD years; 1,357 (43.6%) female; and 1,550 (49.8%) with diabetes. The median GA was 18.7% (IQR, 15.8%-23.3%). During an average 7.9-year follow-up, there were 980 ESKD events, 968 CVD events, and 1,084 deaths. Higher GA levels were associated with greater risks of all outcomes, regardless of diabetes status: hazard ratios for ESKD, CVD, and death among participants with the highest quartile compared with quartile 2 (reference) were 1.42 (95% CI, 1.19-1.69), 1.67 (95% CI, 1.39-2.01), and 1.63 (95% CI, 1.37-1.94), respectively. The associations with CVD and death appeared J-shaped, with increased risk also seen at the lowest GA levels. Among patients with coexisting CKD and diabetes, the associations of GA with outcomes remained significant even after adjusting for HbA1c. For each outcome, we observed a significant increase in the fraction of new prognostic information when both GA and HbA1c were added to models.
Limitations:
Lack of longitudinal GA measurements; and HbA1c measurements were largely unavailable in participants without diabetes.
Conclusions:
Among patients with CKD, GA levels were independently associated with risks of ESKD, CVD, and mortality, regardless of diabetes status. GA added prognostic value to HbA1c among patients with coexisting CKD and diabetes.
Plain-Language Summary:
Hemoglobin A1c (HbA1c) is widely used to estimate glycemia, yet it is less reliable in patients with chronic kidney disease (CKD). There is growing interest in the complementary use of glycated albumin (GA) to improve glycemic monitoring and risk stratification. However, whether GA associates with clinical outcomes in a non-dialysis-dependent CKD population remains unknown. In this cohort study of 3,110 individuals with non-dialysis-dependent CKD, GA levels were independently associated with risks of end-stage kidney disease, cardiovascular disease (CVD), and mortality. The associations with CVD and mortality appeared to be J-shaped. Among patients with coexisting CKD and diabetes, GA added prognostic value to HbA1c. Thus, GA may be a valuable complementary test to HbA1c in patients with CKD.
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